Substrate utilization during 60 min of endurance exercise (50-60%VO₂max) performed in the morning and evening was compared in 11 subjects. After rising at 0600-0630 with a 10-h fast, they exercised without a meal (fasting) or after intake of 40g of carbohydrate feeding (snack) . In addition, subjects consumed curry and rice for lunch 4-h before exercise and exercised at about 1630 (evening) .
In the fasting trial, there was no significant change in plasma glucose (J 100.8 vs 93.0; R 101.0 vs 105.6 mg/dl) before and after exercise between the joggers (J) and the runners (R) . However, plasma glucose in only one subject, who had no night meal, decreased to less than 70 mg/dl. Also, although the plasma free fatty acid level was elevated by more than 50% in both groups, the highest value observed was 0.86 mmol/l. Therefore it was suggested that no subjects developed hypoglycemia and weakness that plasma free fatty acid was not markedly elevated during 60 min of endurance exercise after the fasting trial, whereas there was a tendency for plasma β-hydroxybutyrate to be increased in the joggers compared with the runners.
The availability of blood-borne substrates in the trial evening was characterized by a two-fold elevation (p<0.01) of the insulin level prior to exercise, a 10% decline in plasma glucose and suppression of the normal increase in plasma glycerol and FFA turnover during exercise compared with the other two trials, whereas the results for the fasting and snack trials were similar.
The total energy expenditure for 60 min of exercise in the snack trial was significantly 4-5 % higher than in the fasting and evening trial (mean ± SE= 654.4 ± 26.7 kcal, 619.2 ± 21.2 kcal and 627.5 ± 27.5 kcal, respectively) . Percentage of energy obtained from lipid was determined based on the respiratory quotient, which was similar (48.6 vs 49.7%) between the fasting and snack trials. This, however, differed significantly (p<0.01) from the percentage of lipid metabolized (32.6%) during the evening trial. These data indicate that fasting and snack trials in the morning result in preferential oxidation of fat during endurance exercise.

Aortitis is an inflammatory arteriopathy that often progresses to obliteration of multiple large arteries. Surgical treatment for obstructive lesions due to aortitis syndrome therefore is difficult in many cases. The patient was a 23-year-old female who at the age of 19 had been diagnosed as aortitis syndrome with cerebral vessel involvement, and she subsequently received steroids. She increasingly experienced syncopal attacks, and was indicated for surgical treatment. Angiography revealed obstruction of the left common carotid and left subclavian arteries, and severe stenosis of the right common carotid and right vertebral arteries. She underwent bilateral ascending aorta-carotid artery bypass operation with 7mm ring-supported EPTFE grafts. After the operation she developed clinical signs of temporary brain damage due to hyperperfusion syndrome, but she now completely recovered and maintains a good clinical condition.

We studied the incidence of associated ischemic heart disease (IHD) among 143 consecutive patients (male 118, female 25, mean age 68.5±6.9 years) operated upon for abdominal aortic aneurysm (AAA), excluding ruptured aneurysms. The screening of IHD was routinely performed by using dipyridamole thallium scintigraphy, and when it was positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged positive for IHD. Sixty-two patients (43%) with AAA were simultaneously afflicated with IHD. We also compared the 62 AAA patients with IHD with the remaining 81 AAA patients in this series. The patients with IHD had higher incidences of risk factors such as diabetes mellitus (p=0.0031) and hyperlipidemia (p=0.0029) than those without IHD. Five patients were operated on for AAA after coronary artery bypass grafting (CABG), 11 were operated on for AAA and IHD (CABG) simultaneously, 10 were operated on after PTCA, thirty-two patients underwent elective surgery for AAA and four had emergency procedures due to impending rupture of AAA with continuous infusion of nitroglycerin with or without diltiazem. There was no significant difference in surgical mortality between AAA patients with IHD and those without IHD (3%vs2%), and no cardiac death in this series. When both AAA and IHD are severe enough to warrant surgical treatments at the earliest opportunity, we recommend concomitant operations for AAA and IHD (CABG) since these have been performed quite successfully in our series.

PURPOSE: In cardiac 2-[F-18]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) examination, interpretation of myocardial viability in the low uptake region (LUR) has been difficult without additional perfusion imaging. We evaluated distribution patterns of FDG at the border zone of the LUR in the cardiac FDG-PET and established a novel parameter for diagnosing myocardial viability and for discriminating the LUR of normal variants. MATERIALS AND METHODS: Cardiac FDG-PET was performed in patients with a myocardial ischemic event (n = 22) and in healthy volunteers (n = 22). Whether the myocardium was not a viable myocardium (not-VM) or an ischemic but viable myocardium (isch-VM) was defined by an echocardiogram under a low dose of dobutamine infusion as the gold standard. FDG images were displayed as gray scaled-bull's eye mappings. FDG-plot profiles for LUR (= true ischemic region in the patients or normal variant region in healthy subjects) were calculated. Maximal values of FDG change at the LUR border zone (a steepness index; S(max) scale/pixel) were compared among not-VM, isch-VM, and normal myocardium. RESULTS: S(max) was significantly higher for n-VM compared to those with isch-VM or normal myocardium (ANOVA). A cut-off value of 0.30 in Smax demonstrated 100% sensitivity and 83% specificity for diagnosing n-VM and isch-VM. S(max) less than 0.23 discriminated LUR in normal myocardium from the LUR in patients with both n-VM and isch-VM with a 94% sensitivity and a 93% specificity. CONCLUSION: S(max) of the LUR in cardiac FDG-PET is a simple and useful parameter to diagnose n-VM and isch-VM, as well as to discriminate thr LUR of normal variants.
Aged ; Aged, 80 and over ; Echocardiography ; Female ; Fluorodeoxyglucose F18/*metabolism ; Humans ; Male ; Middle Aged ; Myocardial Infarction/metabolism/pathology ; Myocardium/*metabolism/*pathology ; Positron-Emission Tomography ; Young Adult